The Unanticipated Consequences of Postponing the Employer Mandate

Today's post was shared by NEJM and comes from www.nejm.org

The Obama administration's decision to postpone implementation of the employer mandate is the latest in a series of delays and alterations of the Affordable Care Act (ACA). But postponing the mandate — which requires larger employers to offer lower-income workers health insurance coverage similar to that available in the new insurance exchanges, on equal and affordable financial terms — may create large ripple effects. The good news is that as compared with instituting the mandate as planned, postponing it should barely increase the number of uninsured Americans after ACA implementation. But it affects other provisions, particularly the individual subsidies for purchasing insurance, and creates distorted incentives that may leave the government paying significantly more than planned.

More than 90% of Americans who obtain private health insurance today receive it through employers, but the centerpiece of the ACA's effort to make coverage more attractive to the uninsured focuses on insurance exchanges for individuals purchasing coverage directly. However, because both consumers and employers can in principle finance or obtain private health insurance in either setting, ACA provisions had to be compatible with both coverage channels. Moreover, the legislation created tax-financed subsidies for buying insurance only through the exchanges while relying largely on regulations and mandates to deal with employment-based coverage. Inevitably, this grafting of a new...

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Illinois: Employer Convicted of a Felony for Failure to Have Workers' Compensation Insurance

The Illinois Worker’s Compensation (IWCC), in conjunction with the Cook County State’s Attorney’s Office Special Prosecutions Division and the Cook County Sheriff’s Office, has secured the first felony conviction for failure to secure workers’ compensation insurance. 

Mr. Ahmed Ghosien, d/b/a Ghosien European Auto Werks, refused to comply with Illinois law despite having been given several opportunities to become compliant.  After aggressive enforcement efforts, on July 25, 2013, Mr. Ghosien entered a guilty plea to the Class 4 felony (People v. Ahmed Ghosien, 12 CR 20949).  This is the first felony conviction against an employer for failure to obtain workers’ compensation insurance since the penalty increase, from a misdemeanor to a Class 4 felony, was introduced in 2005 and remained a critical part of Gov. Quinn’s reforms to the Worker’s Compensation Act in 2011.

Holes in the Safety Net — Legal Immigrants' Access to Health Insurance

Immigrant workers are entitled to workers' compensation benefits in most jurisdictions even if they are in the US without status. Ongoing Congressional changes to the nation's immigration system will have significant impact on the delivery of healthcare to immigrant workers.Today's post was shared by NEJM and comes from www.nejm.org

While Congress debates whether publicly supported health care should be available to undocumented immigrants who may be placed on a path to citizenship under immigration reform, the health care needs of already legal immigrants continues to be overlooked.

More than 12 million immigrants are lawfully present in the United States. They serve in the military, pay taxes, and contribute to the economy. Yet like undocumented immigrants, whose health care vulnerabilities are outlined in the Perspective article by Sommers, legal immigrants face substantial barriers to obtaining insurance coverage (see graph Health Insurance, According to Citizenship Status, 2009.). As a result, some — such as Antonio Torres, an uninsured Arizona farmworker who was in a coma after a car accident — have been forcefully transferred to their native country when their treating hospitals were unable to find facilities willing to provide them with long-term care.1

WellPoint Sees Small Employers Dropping Health Coverage

Complicating the health insurance scene is the fact that injured workers who been denied workers' compensation benefits might have no safety net under Obamacare. As the system rolls out, in those situations, the states with slow disposition rates of workers' compensation claims will become fertile jurisdictions for workers' compensation reform to remedy this injustice. Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

 1.

As the nation prepares to roll out the next phase of Obamacare, the second biggest medical insurer said Wednesday that it expects to lose members in health insurance plans sponsored by smaller employers.

“I would not call it an academic assumption at this point,” WellPoint chief financial officer Wayne DeVeydt said on a conference call with stock analysts. “We continue to see small group attrition accelerate even more as we get to the back half of the second quarter. And we expect that to continue.”

The lost customers aren’t just signing up with WellPoint rivals, according to DeVeydt. “Some of it is going into the uninsured ranks,” he said. At the same time, WellPoint expects membership gains in self-insured employer plans and in the kind of individual plans that will be sold in subsidized exchanges starting Oct.

The Obama administration recently postponed enforcement of a requirement that employers with 50 employees or more offer health coverage next year or face fines. But the delay in the “employer mandate” wasn’t the reason WellPoint gave for losing small-group members. Nor did executives respond directly to analyst’s questions about whether small employers are “dumping” workers into the subsidized individual market.

Rather, small employers have hesitated to buy coverage for next year because of uncertainties surrounding the online exchanges offering individual and small-group plans, the...

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Governor Christie Vetoes First Responder Workers' Compensation Bill

NJ Governor Chris Christie has vetoed legislation that would would have created a presumption that of compensability for first responders who contracted cancer. He calls NJ workers' compensation system "successful" as is.

S-1778/A-1196 (Greenstein/Stender, Egan, O’Donnell, Wimberly) – ABSOLUTE -  ‟Thomas P. Canzanella Twenty First Century First Responders Protection Act”; concerns workers’ compensation for public safety workers.

July 18, 2013 
SENATE BILL NO. 1778 
(First Reprint) 
To the Senate: 
 Pursuant to Article V, Section I, Paragraph 14 of the New 
Jersey Constitution, I am returning Senate Bill No. 1778 (First 
Reprint) without my approval. 
 Since New Jersey’s workers’ compensation law was enacted 
more than a century ago, the unique circumstances surrounding 
workplace injuries of all employees – including our State’s 
public safety workers – have been considered in the context of 
the fact-sensitive circumstances surrounding each incident. 
This time-tested process appropriately balances all facts 
necessary to determine a proper compensation award. In 
contrast, this bill alters that careful balance by providing 
public safety workers with a presumption to workers’ 
compensation, rebuttable only by clear and convincing evidence. 
This sweeping new standard would apply to disabilities 
associated with an array of enumerated incidents and, in some 
cases, disabilities not tethered to any work-related incident at 
all. 
As a State, we must continually recognize the selfless 
contributions of our first responders. Day in and day out, 
these brave women and men make enormous sacrifices in order to 
ensure our collective safety, health, and well-being against all 
manner of threats. That essential public service, and the costs 
associated with the injuries those duties may cause, must be 
administered in a responsible manner that matches our public 
resources. Although this measure would likely have a 
significant impact on State, local, and municipal government 
budgets, the bill’s sponsors refused to obtain a fiscal analysis 
or refer the bill to either house’s respective budget  
committees. Regrettably, the Legislature’s failure to pursue 
the responsible course of thoroughly reviewing the significant 
changes to a successful and long-standing system, and the 
corresponding impact of this proposal on taxpayers, prevent my 
approval. 
Our public safety workers are vital to our State and I am 
committed to ensuring their well-being and protection. Reasoned 
suggestions for improving those practices should be openly and 
honestly evaluated. While I welcome a discussion on new ways to 
enhance the lives of emergency responders, the truncated and 
insufficient manner in which this proposal was prepared and 
passed is not consistent with our responsibility as elected 
representatives of all citizens. 
 Accordingly, I herewith return Senate Bill No. 1778 (First 
Reprint) without my approval. 
Respectfully, 
 [seal] /s/ Chris Christie 
 Governor 
Attest: 
/s/ Charles B. McKenna 

Chief Counsel to the Governor 

Read more about workers compensation and Governor Christie

NJ Governor Christie to Propose Workers' Compensation Reform

Apr 23, 2013

“'We're going to be coming up with a package of proposals that's going to work both sides of that,' Christie told a caller on his monthly NJ 101.5 FM radio show tonight. 'The employers who may not be stepping up and meeting ...

http://workers-compensation.blogspot.com/
....
For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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Alleged Claim of Assault by Employer Results in a Dismissal

A car salesman, who alleged that his employer punched him in the ear, was denied workers' compensation benefits. The claimant, who presented a claim for total permanent disability, was unsuccessful, after the trial judge found the worker just not credible.

The judge, Ronald Allen, NJ Judge of Compensation, based his dismissal on the evidence, after the

employer testified that the accident never occurred  the worker never filed a criminal complaint against the employer, and the the employee did not seek immediate medical treatment.

The employer's medical expert, Dr. Aragona, testified that the employee lacked complaints and  the clinical neurological examination was normal.

Furthermore, the Judge found that the petitioner's expert did not take into consideration a serious prior medical condition.

The Appellate Court held that it would not disturb the trial decision as there was insufficient evidence the the trial Judge's credibility determinations were in error.

Schofel v. Route 22 Nissan, NJ App Div A-5924-11T4, Decided July 11, 2013.

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Connecticut Employers Shut Down For Not Paying Workers' Compensation Insurance

Today's post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

In these tough economic times, many companies aren’t paying basic requirements for their employees like Social Security, income taxes, unemployment, or workers’ comp. This has led states all over the country to start doing spot-checks on construction sites.

Employers beware – protect your workers with workers’ compensation insurance – it’s the law, and states are cracking down. Just this week

Connecticut’s Labor’s Wage & Workplace Standards Division shut down two subcontractors who were helping to build a high-rise in Stamford, CT.

According to the state, the Virginia-based contractors couldn’t provide evidence that their employees had workers’ compensation coverage in the state of Connecticut. With unemployment high and the recession lingering, employers seem to be increasingly taking advantage of the fact that people are willing to work without appropriate coverage.

 It is a real shame that these days so many people are going to work without the protections that they are due under the law.

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The American Workforce is Working At Home

What is considered "Off-Premises Work" is now a rapidly changing concept in workers' compensation. Challenging compensability is therefore becoming a more difficult concept for employers.

AMERICAN TIME USE SURVEY —2012 RESULTS

In 2012, on days they worked, 23 percent of employed persons did some or all of their work at home,
the U.S. Bureau of Labor Statistics reported today. Among workers age 25 and over, those with a
bachelor’s degree or higher were more likely to work at home than were persons with less education—
38 percent of those with a bachelor’s degree or higher performed some work at home on days worked
compared with 5 percent of those with less than a high school diploma.

These and other results from the American Time Use Survey (ATUS) were released today. These data
include the average amount of time per day in 2012 that individuals worked, did household activities,
and engaged in leisure and sports activities.

• Employed persons worked an average of 7.7 hours on the days they worked. More hours were worked, on average, on weekdays than on weekend days—8.0 hours compared with 5.7 hours.
• On the days they worked, employed men worked 55 minutes more than employed women. This difference partly reflects women’s greater likelihood of working part time. However, even among full-time workers (those usually working 35 hours or more per week), men worked longer than women—8.5 hours compared with 7.9 hours.
• Many more people worked on weekdays than on weekend days—83 percent of employed persons worked on an average weekday, compared with 34 percent on an average weekend day.
• On the days they worked, 85 percent of employed persons did some or all of their work at their workplace and 23 percent did some or all of their work at home. They spent more time working at the workplace than at home—7.9 hours compared with 3.0 hours.
• Multiple jobholders were more likely to work on an average day than were single jobholders—83 percent compared with 67 percent.
• Self-employed workers were nearly three times more likely than wage and salary workers to have done some work at home on days worked—56 percent compared with 20 percent. Self-employed workers also were more likely to work on weekend days than were wage and salary workers—42 percent compared with 31 percent.
• On the days they worked, 38 percent of employed people age 25 and over with a bachelor’s degree or higher did some work at home, compared with only 5 percent of those with less than a high school diploma. 

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NJ Workers Compensation Companies Pay More for Hospital Fees

NJ workers' compensation insurance companies pay more for hospital charges than group health plans, according to a recent study published by the WRCI. NJ workers' compensation statute mandates a closed panel system were the the company must authorize the medical provider.

"The average workers' compensation payment for shoulder surgery in New Jersey was $7,323. Group health plans paid only $4,583 on average, a difference of $2,740, or 37 percent less.

For knee surgery the workers' compensation insurers' cost was $5,547, 42 percent higher than amounts paid through group health plans, which included the co payments and deductibles paid by the patients."

Click here to read: "Study: NJ workers comp insurers pay higher fees to hospitals than group insurers" The Record

Read more about medical treatment and workers' compensation:
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NJ Bayonne Medical Center - Highest Priced Medicine in the Nation
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The cost of medical care has increased tremendously according to a recently issued report. The NCCI (National Council on Compensation Insurance Inc.) reports an increase in medical costs from 40% in the early 1980s to .
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The 12 Things You Must Do If You Are Hurt At Work

Today's post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

Injured workers call me all the time asking me what they need to do to make sure they protect their legal rights.  If you are hurt on the job, whether it is due to an acute traumatic injury (like cutting yourself on a saw), cumulative-trauma injury (like carpal-tunnel syndrome) or some other job-related injury, there are several basic things you should do. If you do not do any of the things on the list below, you may lose your rights under workers’ compensation law. 

Although there may be rare exceptions to this list,  following it will leave you reasonably secure that your rights are protected:

1. Report the injury. By “injury,” I mean almost any condition including but not limited to (a) an acute traumatic injury, (b) a cumulative-trauma injury, or (c) a disease or a hearing loss. You should report the injury to your supervisor or company nurse (for clarity we’ll just call these people your Supervisor from here on out), making clear your injury was caused by work. Under Iowa law, you need to make the report within 90 days of the date of your injury.
2. Make sure your Supervisor prepares a company accident report.  If your Supervisor won’t prepare the report,

Single Payer A Possibility for New York City Employees

The single payer medical benefit system, a program that brings workers compensation into a universal care program, maybe the future for NY City employees. Anthony D. Weiner, a Democratic Candidate, is proposing the change.

"Vowing to “make New York City the single-payer laboratory in the country” if he is elected

mayor, Anthony D. Weiner on Thursday presented an ambitious plan to create a Medicare-like system for the coverage of municipal workers, retirees and uninsured immigrant residents left out of the Affordable Care Act."

Click here to read: "Weiner Wants City to Test Single-Payer Health Care" The NY Times

NJ Uninsured Fund Cracks Down on Uninsured Employers

It has been reported tat the NJ Uninsured Fund is vigorously seeking reimbursement for assessments and penalties from employers who do not have workers' compensation insurance. 

In a recent case, a former employer was required to reach a deal with the NJ Attorney

General's Office to repay $111,813.00. It was reported that the former employer had to mortgage his house for repayment in order to avoid a potential 18 month prison term and a $10,000 fine in addition to the assessment.

Click here to read: Franklin Lakes business owner must mortgage home to avoid jail in workers compensation case